As first published on TerryFletcher.net
This is a revision by the same author, Terry Fletcher CPC, CCC, CEMC, CCS, CCS-P, CMS, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM, PACS.

We have been receiving many inquiries and emails regarding the billing of Audio Only Telehealth for Medicare and Commercially Insured patients starting January 1^st, 2025. The published guidance is muddy at best, and a lot has to be “inferred” from the Final Rule, the Federal Register, and the last CR (continuing resolution), to even begin to unfold the direction to our healthcare professions on billing.

First, read the “fine print”. All of the published guidance, states, “…while real-time interactive audio-video remains the generally applicable standard, including for distant site practitioners who wish to furnish these services, there are special considerations for patients when a Medicare telehealth service is delivered in their home. For example, a patient may not have sufficient (or any) access to broadband to support the use of real-time video technology, may not have the technical proficiency or support in place to use video technology, or may have privacy concerns about using video technology for Medicare telehealth services in their home…”

FR in § 410.78(a)(3), page 97761

This language is after every entry relating to audio only telehealth services, meaning that audio only is for “certain circumstances” or “special considerations”, not the norm or for the routine use. Remember, the only reason telehealth audio only was opened up for payment in April of 2020, at the height of the pandemic, is because our older, Medicare population had difficulty connecting to video technology for different reasons and HHS and CMS did not want to limit this population of patients’ access of care.

However, we are now 2-years removed from the end of the PHE (pandemic) as it ended May 2023, so to justify the need or medical necessity of an audio only, that again is “analogous to, and must include the elements of, the in-person service”, is hard to support. As we like to say in the coding and compliance world, “make it make sense”.

The Federal Register is clear that the rules or circumstances for “audio-only” has to “reflect this limited exception to address the unique considerations of patients who may receive Medicare telehealth services in their homes, as stated in the CY 2025 PFS proposed rule, we proposed a policy that would permit a patient driven choice to use audio-only technology to receive a Medicare telehealth service based on their technological capabilities and limitations, and their comfort level with the use of video technology in their home.” FR in § 410.78(a)(3), page 97761, 5^th paragraph.

If the criteria or circumstances are met for the audio only telehealth services, we are instructed to use the -93 modifier (although this is not on the Appendix T list as appropriate for office or other patient visits in CPT. This is specific to Medicare), and the place of service below. We would not advocate for audio only for New Patients, as this was ended in 2023.

The Audio and Video Telehealth will continue as it did in 2024, through March 31^st, 2025. The POS (Place of Service) options also will continue as stated below.

• Place of service (POS) codes will continue to have two telehealth designations:
  • 02 Patient not in their home when telehealth services are rendered; or
  • 10 Patient in their home when telehealth services are rendered. POS 10 will continue to be paid at the non-facility rate.
• CMS will continue to allow physicians to list their practice address, rather than their home address, when performing Medicare services via telehealth from their home, but again, they say this is a rare occurrence.
• Teaching physicians may continue to have a virtual presence in all teaching settings, but only for Medicare telehealth services. This was only extended 1-year through Dec. 31, 2025.
• Both patient and any approved Telehealth provider must be in the U.S. (including U.S. territories) when the services are done. The Telehealth provider but be licensed in the state they are in and the state the patient is in at the time the telehealth service is rendered.
• Out of country (U.S.) medical services are not covered by Medicare via telehealth or otherwise.

Authoritative references are provided in the resources section to allow you to source the information yourself.

Congress Could Change Everything:

We are going to be watching very closely with a new government administration incoming as of January 20^th, 2025. We will have a new HHS Secretary, Robert F. Kennedy Jr., along with a new CMS Director, heart surgeon, and former TV personality, Dr. Mehmet Oz M.D.

They may have different ideas for Telehealth and how it is allowed and even reimbursed. So, stay tuned for that possible change.

References and Resources

https://www.federalregister.gov/documents/2024/12/09/2024-25382/medicare-and-medicaid-programs-cy-2025-payment-policies-under-the-physician-fee-schedule-and-other p.97760-97761

https://www.congress.gov/bill/118th-congress/house-bill/10545